So, to summarize: in the past fifty years, education costs have doubled, college costs have dectupled [10 times], health insurance costs have dectupled, subway costs have at least dectupled, and housing costs have increased by about fifty percent. US health care costs about four times as much as equivalent health care in other First World countries; US subways cost about eight times as much as equivalent subways in other First World countries.

I worry that people don’t appreciate how weird this is. I didn’t appreciate it for a long time. I guess I just figured that Grandpa used to talk about how back in his day movie tickets only cost a nickel; that was just the way of the world. But all of the numbers above are inflation-adjusted. These things have dectupled in cost even after you adjust for movies costing a nickel in Grandpa’s day. They have really, genuinely dectupled in cost, no economic trickery involved.

And this is especially strange because we expect that improving technology and globalization ought to cut costs. In 1983, the first mobile phone cost $4,000 – about $10,000 in today’s dollars. It was also a gigantic piece of crap. Today you can get a much better phone for $100. This is the right and proper way of the universe. It’s why we fund scientists, and pay businesspeople the big bucks.

But things like college and health care have still had their prices dectuple. Patients can now schedule their appointments online; doctors can send prescriptions through the fax, pharmacies can keep track of medication histories on centralized computer systems that interface with the cloud, nurses get automatic reminders when they’re giving two drugs with a potential interaction, insurance companies accept payment through credit cards – and all of this costs ten times as much as it did in the days of punch cards and secretaries who did calculations by hand.

But:

I don’t have a similar graph for subway workers, but come on. The overall pictures is that health care and education costs have managed to increase by ten times without a single cent of the gains going to teachers, doctors, or nurses. Indeed these professions seem to have lost ground salary-wise relative to others.

I also want to add some anecdote to these hard facts. My father is a doctor and my mother is a teacher, so I got to hear a lot about how these professions have changed over the past generation. It seems at least a little like the adjunct story, although without the clearly defined “professor vs. adjunct” dichotomy that makes it so easy to talk about. Doctors are really, really, really unhappy. […] Read these articles and they all say the same thing that all the doctors I know say – medicine used to be a well-respected, enjoyable profession where you could give patients good care and feel self-actualized. Now it kind of sucks.

Meanwhile, I also see articles like this piece from NPR saying teachers are experiencing historic stress levels and up to 50% say their job “isn’t worth it”. Teacher job satisfaction is at historic lows. And the veteran teachers I know say the same thing as the veteran doctors I know – their jobs used to be enjoyable and make them feel like they were making a difference; now they feel overworked, unappreciated, and trapped in mountains of paperwork.

The legal issues would appear to be silly. So why’s the Supreme Court not only hearing this case, but giving so much time to it?

The Supreme Court has been under a cloud since Bush v. Gore, when it massively distorted the law in order to install its preferred candidate as president – a president who, it turned out, was one of the most incompetent in American history. Perhaps their rush to take this case is a bid for renewed legitimacy. It’s no great legal feat to say that silly arguments are silly, and on that basis to uphold the ACA [Affordable Care Act of 2010]. The Court generally occupies itself with hard cases, not easy ones. But this prominent case, which they have made even more prominent by dragging on argument for days, lets it say to all the Gore supporters (and the very large number of Bush supporters with buyers’ remorse) that, see, we’re nonpartisan and legitimate after all. As a legal matter, the answer is obvious, and as a political matter the advantages are delicious. Who could resist?

America’s health care spending crisis is a concentrated phenomenon. The challenge isn’t just about making everybody’s insurance cheaper (although that would be nice). It’s about figuring out how to cut costs, wisely and fairly, for the disastrously ill and preventing diseases before they become chronic. This is America’s 5% problem.

What’s needed isn’t just big ideas. It’s people fulminating for them – making enough of a ruckus that the ideas can’t be ignored. They become part of the debate because the public demands it.

Two, jobs:

The nation needs a real jobs plan, one of sufficient size and scope to do the job – including a WPA and a Civilian Conservation Corps, to put the millions of long-term unemployed and young unemployed to work rebuilding America.

Three, to address long-term debt, raise money by:

What about halving the military budget …? It doubled after 9/11, and military contractors are intent on keeping it in the stratosphere. . . .

And what about really raising taxes on the rich to finance what the nation should be doing to create a world-class workforce with world-class wages? . . . Incomes of more than $5 million should be subject to a 70 percent rate. (The top marginal rate was never below 70 percent between 1940 and 1980.) And these rates should apply to all income regardless of source, including capital gains. . . .

And a tax on financial transactions. Even a tiny one of one-half of one percent would generate $200 billion a year. That’s enough to make a major contribution toward early childhood education for every American toddler. Continue reading →